Provider Demographics
NPI:1295980563
Name:MILLETT, ANTONELLA (FMG)
Entity type:Individual
Prefix:DR
First Name:ANTONELLA
Middle Name:
Last Name:MILLETT
Suffix:
Gender:F
Credentials:FMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 JAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3466
Mailing Address - Country:US
Mailing Address - Phone:408-390-8895
Mailing Address - Fax:
Practice Address - Street 1:1141 JAN AVE
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3466
Practice Address - Country:US
Practice Address - Phone:408-390-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program